When Jayne was four or five, she pretty much controlled the house. Somehow she had figured out exactly what she could get away with. She also was able to figure out where her parent's weak points were. More amazingly, she figured out where the weak points in their marriage were. This got so bad that her parents went to marriage counseling and finally adopted a policy of "united we stand, divided we fall" in regards to Jayne. This certainly helped keep Jayne in line in her elementary school years. Jayne also had ADHD, but it was never too severe. She only had to take medication for a few years at the end of elementary school. As she became a teenager, she began to have problems. The loss of a boyfriend led to cutting her wrists.

She always was in some sort of turmoil with her friends or the youth group. People were always trying to "save" her. The school counselor and the youth group leader both "knew in their hearts" that Jayne needed a lot of attention and special care and encouraged her parents to be more understanding on her sensitive nature. Jayne's grandfather said that he "knew in his heart" that Jayne needed a swift kick in the rear. As the teenage years went on, these problems just continued. She got involved in some minor crimes like shoplifting, tried vomiting to lose weight, and smoked pot. Each time she made such a big deal about the whole thing that her parents could hardly stand it. When she was 18, she moved in with an older guy who she thought "really understood her". They have been separated about six times so far. Her life continues in turmoil.

This points out the fact that sometimes, even with great parenting, things don't turn out so well. However, many times with aggressive intervention things go more like this:

Ricky-

Ricky was always hyper and always quite the con artist. The neighborhood mother's never really trusted him. He got referred after he hit the teacher hard enough to knock her down in second grade. We did everything. He took medications for his ADHD. The parents followed through with every type of intervention for ODD. He was very involved in cadets as a teenager. When he was about 19, I met his mother in a store. She wanted to tell me how well he turned out. He was still a bit of a hot head and was still on meds for ADHD, but he was working and had a steady girlfriend. He was hoping to join the militia. Ricky had turned out just fine.

Sadly, this is very common. In my clinic, every youngster with CD is assumed to be abusing substances until proven otherwise. Compared with kids who do not have CD, kids who have CD are three times more likely to smoke cigarettes, 2.5 times more likely to drink, and five times more likely to smoke pot. As far as having a problem from drug use, kids with CD a 5.5 times more likely to be addicted to cigarettes, six times more likely to be alcoholics, 7 times more likely to be addicted to pot. This is certainly the most common comorbidity and often goes along with the ones below.

John-

When John was 9, he told his mom that he wanted to buy lunch instead of bring it. His mom at that point still believed that some of what John said was innocent of any other purpose, and so she let him. She did notice that he was very hungry when he came home from school. He said the lunches were small and for an extra 75 cents he could get seconds. She believed this. Two weeks later the principal called to report that John was caught with cigarettes on the playground. John's mom was amazed, as she did not smoke and neither did her husband. Not only that, but he had a whole pack. Well, it took a lot of "interrogation" to get the story out. The lunch money went to buy cigarettes from a boy in Jr. High. John then smoked a few of those and then sold the rest at a big profit. His parents remembered that two years later when he was found drunk in the locker room at Jr. High. Now his parents are lots wiser. John still thinks his parents are totally unreasonable. The rule is you get your allowance and phone privileges as long as those random urine drug screens are normal. If he doesn’t cooperate, then they are assumed to be positive. So he ended up poor and lonely for a few weeks, but now that is under control. As far as cigarettes go, if he can buy them, he can smoke them outside. If he is caught drinking or around people who are drinking, good-bye allowance and phone. John hates it and can't wait until he moves out so he can finally do what he wants.

Conduct Disorder (CD) plus ADHD—

When these two disorders are present, usually the ADHD symptoms are much more severe than when ADHD is present without CD.

Michael-

Michael is now 14. When his mother thinks back to his infancy, she could actually see it coming at age 18 months. At that age he got up in the middle of the night, put a chair up to the door, opened it and went walking outside. The cops found him a while later and brought him home. If only that had been his only contact with them!

Michael's mother hated school almost as much as Michael did. Almost every day there were calls from the school about Michael. In grade primary he tried to stab a youngster with scissors. He was swearing at his teachers by grade one. On Grade two it was stealing lunch money. Every time they seemed to get one problem under control, he was into something else. Everyone seemed at a loss about what to do except her brother. It didn't matter what the weather was like, Michael was out there. His uncle said that by the time he was ten, he could do the work of a grown man. There was no fear in Michael. Cold weather, big swells, nothing bothered him. He refused to do any homework from fourth grade on. Up until that grade, his teachers let him go out for a walk around the building every hour or so, but when a set of keys went missing and were "discovered" by Michael a few days later, the walks ended. Still, compared to the last few years, this was easy.

Michael was suspended from 7th grade after two weeks when he threw a match into a boy's locker. Why? The boy called him stupid. He was out for a week, then after only two more days, he was thrown out for making death threats against the teacher. His parents tried home school and they thought they were getting somewhere - until they got a call from the bank. They were overdrawn. When it all came out Michael had stolen the cash card and figured out the password and had taken out $500 dollars. They still don't know how he did it. Before they could even sort that out, Michael was arrested for vandalizing the school. He would have only received probation, but after giving the judge the finger, he was sent to the MCYC Youth Center. It was the staff there that finally figured it out. This guy could not sit still for anything, he said the first thing that came to his mouth, and was constantly getting in bigger trouble for it. He saw the doctor, ADHD was diagnosed, and he was given medication for this in the Youth Centre. But what will happen in two months when he gets out? His mother spends a lot of sleepless nights thinking about that.

Conduct Disorder (CD) and Depression—

Kara-

Kara is 14, too. Her life didn't start out quite so difficult. In fact, her mom swears that until she was almost 10, there were no problems. That is hard for everyone to believe now. Her mom remembers thinking that Kara was certainly starting the teen years early. At age 11 she was having a tantrum about not being able to go out with her boyfriend who was 15. You could hardly blame her. By the time Kara was 11, she looked like she was 15 or 16. Unfortunately, she did not have the maturity of a 16 year old. She ran away from home at age 12 for a week before they could find her. She brought a bottle of rum to school and got drunk. But more than this, she was absolutely unbearable to live with. She had become super defiant, and would fight her parents or anyone else for no reason at all. She never seemed happy, just angry. Unless she was with her friends, which by age 13 or 14 were 18 or so. Her parents kept asking themselves, "what had happened to their old daughter?” She was failing in school mostly because she was never there. She was never where she told her parents she said she was. The first clue came when she came home high on something and told her parents she was going up stairs to bed. They heard a crash and came in the bathroom to find her trying to cut herself with a broken mirror. Kara wanted to die. Her boyfriend of two months had left her. For a few weeks she just hung around the house and lay on her bed and listened to music. Her parents let her out one night to go to her girlfriend's house. They got a call later that night that Kara had admitted to taking a half a bottle of Tylenol.

It is not uncommon that a mood disorder along with CD gets missed. There are usually so many pressing problems to sort out and so many different stressors, that it isn't until suicide is tried or talked of that many families, physicians, and other health professionals consider comorbid depression. Recent studies of teenagers who have committed suicide have found that these kids are about three times more likely to have CD and 15 times more likely to abuse substance. Suicide is worth worrying about in CD.

Conduct Disorder (CD) plus Tourettes, OCD, and ADHD—

Jake-

Jake is now 12. He has seen more doctors, nurses, and psychologists than most people will see in a lifetime. His father worried that maybe his son could have Tourette's like him, but he never dreamed it could get like this. When he was 4 he was thrown out of pre-school for fighting. Because of his reputation, he was the first youngster where the school approached the parents about getting a teacher's aide in grade primary rather than the parents approaching the school. Lucky for Jake, he never seemed to have all of these problems at once. Usually he would have a tic, especially blinking, which would last a few weeks or so. Then he would have to touch things, and then that might go away, too. The tics and OCD were nothing compared to his behavior. His temper was incredible. The usual pattern was that the excitement of being around other kids would get him so wound up that he was literally bouncing around. This usually led to pushing, fighting, and punishment. He resisted this and usually ended up being sent home as they could not deal with him. He attacked him sister. He attacked his mother and broke her arm. That led to living with different relatives and now a foster home. No one seemed to be able to manage him. The new foster parents were actually being bothered the most by his poor sleep and a nearly constant vocal grunting tic. They brought him to yet another doctor to see if they could do anything about this. He was placed on some medicine for the tic and amazingly, he behavior improved quite a bit. For the first time his parents are hopeful that maybe he can come home again.

This is the other common combination with ODD. If you look at kids with ODD, probably 15-20% will have problems with their mood and even more are anxious. Here are some examples of how this can present:

Preschool Katherine—

Katherine is 4. She has not been an easy youngster. Her mom does not like to compare kids, but it is hard not to! Her brother is easy to get along with, excited, and energetic. She expected to have arguments with Katherine about doing a chore or task, but she ends up having an argument with Katherine about doing something fun! Katherine's first response to almost any activity is "No, I don't want to". Her mother has learned that if she can get Katherine out the door and to pre-school, for example, she does quite well once she is there. That is, as long as everything is going her way. It does not take much of a problem for Katherine to lose her temper. Two days ago she was called to preschool when another boy bumped Katherine and she dropped her cheese and cracker on the carpet. Katherine belted the youngster and screamed "I hate you, I hate this place, I hate it!" until her mother came. Of course the next day she was back again and things were going alright. Katherine's mother has some unusual memories, or at least she thinks so. She remembers last fall when they took Katherine horseback riding for the first time. Katherine's face showed true joy for a whole hour. Her mother did not know whether to cry or not, as she could not remember such an expression on her youngster's face before for more than a few moments. That memory makes her hopeful that somehow she can bring that joy back to Katherine.

It is not an easy task. The combination of being irritable and oppositional tests everyone's patience. She did not realize how stressful it was until she started bringing Katherine to a babysitter so she could go out and visit her friends. Finally she did not have to be thinking about how to keep Katherine from losing it every minute. She is finally coming to the decision that try as she might, she cannot make Katherine's life as smooth as Katherine wants it.

Elementary School Tommy—

Tommy is 11 years old. Tommy spends a lot of time in his room doing legos and making models. Then, all of a sudden there is a scream and stuff gets thrown around. If his parents are so unwise as to go up there, they will get to hear Tommy say that he hates this world, hates legos, and hates this stupid model. Then he will usually look up and say something awful to his parents. That is why they just leave him up there. He comes home from school crabby and throws his homework down and goes up plays in his room. His parents realize that he needs to get out and do something, but the only thing they can ever get him to do is go lift weights at the YMCA. Tommy's father has absolutely no interest in lifting weights, but he has done a pretty good job of convincing Tommy that he likes to go. That gets him out of the house about three times a week. As far as playing with other kids, unless his cousins come over, he won't play with anyone. His parents used to ask why and the answer was because no one likes me. Sad to say, it is not hard to figure out why Tommy would have that idea. When a friend comes over, he is so demanding and insists that the youngster do things just the way Tommy wants. Usually Tommy ends up sulking part of the time when he doesn't get his way. So now, his mom invites friends over for Tommy, but she plays right along side of the friend and Tommy. At least they aren't scared off that way.

At school, it is even worse. Everyone seems to know how easy it is to get Tommy to lose his temper. It happens almost every day. He bangs the desk, takes a swing at someone, swears, or kicks them. He is usually caught, and since he is so irritable anyway, the teachers hear a fair amount of defiance. Amazingly, he does pretty well in school once he gets going on something. This year he has changed classes. His old teacher was humble enough to admit that Tommy had pushed her too far and she could not take it any longer. She said she just could not remain professional. Tommy's mom knows how that could happen. Sometimes she just takes off for a walk when Tommy is driving her nuts. She knows she shouldn't leave him alone at home, but she figures if she doesn't go out in the woods for a walk there would be far greater dangers awaiting Tommy at home than if he was there alone. Tommy mostly wishes people would just stop bugging him. Once in awhile, right before bed, Tommy will ask him mom if it hurts to die or what it is like to be dead. She can't tell if he means it or is just saying that to bug her. She is afraid to even think about it.

High School Jeremy—

Jeremy is now 18. Things are going great for Jeremy this year. He is back in school, off drugs, and actually is getting along with his parents. In fact, he actually missed them when they went away. He has been helping his Dad put up dry wall after school. Both he and his parents are grateful for his recovery, but they wished they could have picked it up earlier, like when he was 12 or 13. That's when things really started to get worse. Jeremy had always had a hot temper and still does, but then it was unreal. At age 12 his parents would not let him go to a dance. He broke all the windows in their car. He lasted two months in 8th grade before he was suspended for fighting. Jeremy lost the few friends he had by getting kicked off the hockey team. He swore at a judge during a probation hearing and got two months in the Youth Center which was extended to six months after he tried to attack a guard. All the while he was so irritable and never happy. When he came home from the Youth centre he wanted to be able to drive. They said no, and he decided that was it and went out to hang himself in the barn. His parents still remember those words, "You'll all be f-ing better off without me and if you come after me I'll f-ing kill you, too". That horrible day was the turning point. It took five cops to get him to go to the hospital. It took a careful evaluation to figure out that he wasn't just oppositional, stubborn, and hot headed. He was very depressed, too. Now after 6 months of medical and non-medical interventions, he is 100% better. Jeremy admits that if he had to go back to living the way he was, he'd start thinking of suicide.

These examples show how very difficult the combination of ODD and depression can be for the family and the youngster. Often the depression gets mixed in the midst of dealing with the aggression and defiance. I commonly run across kids like Jeremy who have been oppositional and depressed but no one ever notices the depression until they make a suicide attempt. Looking for depression in ODD children is very important.

If a child comes to a clinic and is diagnosed with ADHD, about 30-40% of the time the child will also have ODD. Here are some examples of how this looks across ages:

Pre-school Kaylee—

Kaylee is now 4 years old. Her parents were very excited when she turned four that perhaps that would mean that the terrible twos were finally over. They were not. Her parents are very grateful that the Grandparents are nearby. The grandparents are grateful that Kaylee's aunts and uncles live nearby. Kaylee's Aunt is grateful that this is her niece, not her daughter. Why? Kaylee requires an incredible combination of strength, patience, and endurance.

Kaylee begins her day by getting up early and making noise. Her father unfortunately has mentioned how much this bothers him. So she turns on the TV, or if that has been mysteriously disconnected, bangs things around until her parents come out. Breakfast is the first battleground of the day. Kaylee does not like what is being served once it is placed in front of her. She seems to be able to sense how hurried her parents are. When they are very rushed, she is more stubborn and might refuse it altogether. It would be a safe bet that she would tell her Mom that the toast tastes like poop. This gets her the first “time out” of the day.

In the mornings she goes to pre-school or goes off with her grandmother or over to her aunts. Otherwise Kaylee's mother is unable to do anything. Kaylee cannot entertain herself for more than a few moments. She likes to spend her time purposefully annoying her mom, at least so it seems. Kaylee will demand over and over that she wants something (e.g., play dough). She knows it must be made first. So her mom finally gives in and makes it. Kaylee plays with it about one minute and says, "Let’s do something" . Her mother reminds her that they are doing something, the very thing that Kaylee has been demanding for the last hour. "No, let’s do something else"

So after Kaylee's mother screamed so hard she was hoarse when her husband came home, Kaylee gets to go out almost every morning. At preschool she is almost perfect, but will not ever do exactly what the teacher wants. Only once has she had a tantrum there. Kaylee gets along with the other children as long as she can tell them what to do.

Her grandmother and Aunt all follow the same “time out” plan. This means she goes to a certain room until she calms down. The room is empty now at Kaylee's grandmother. Kaylee broke the toys, and they were removed. She banged the furniture around and it was removed. What sets Kaylee off is not getting to do what Kaylee wants. She screams, tells people she hates them, and swings pretty hard for a four old. After a half hour it is usually over, but not always. Kaylee will usually tell her mom or Grandmother about these tantrums. The story is always twisted a little. For example, Kaylee will tell her Grandmother that her mom locked her in her room because she was watching TV. Her grandmother used to believe these stories, and Kaylee could tell the whole story of how she was watching this show, and her mom just came in and dragged her to her room. Now it turns out that Grandma doesn't think much of TV anyways, and so this made a certain amount of sense to her. This led to more than one heated argument between the Grandma and her mom. Of course there was almost no truth to this at all. It took the tables being turned for the Grandma to really believe that her Granddaughter could set up an argument like this. Kaylee came home and told her mom that Grandma let her eat four cookies and an ice cream cone for a treat and that she was very full. Kaylee's mom doesn't think much of treats, and could see how this might happen and thought she would have to talk to her mom. Finally they both realized what Kaylee was doing.

Most of the afternoon with Kaylee is spent chasing her around trying to wear her out. It doesn't seem to work, but it is worth a try. When she is at her aunts, she tries to wreck her cousin’s stuff. When is she good? When there are no other cousins around and she has the complete attention of her Aunt or Grandpa.

Kaylee loves the bedtime battle. She also loves to go to the Mall. But she never gets to go there or hardly anywhere else. She acts up so badly that her family is very embarrassed. Her mother shops and visits only when Kaylee goes to preschool. It is hard to know who is more excited about Kaylee going to school next year, her mother or Kaylee!

Elementary School Toby—

Toby is 10. Toby's day usually starts out with arguing about what he can and can not bring to school. His mother and his teacher have now made out a written list of what these things are. Toby was bringing a calculator to school and telling his teacher that his mother said it was alright. At first his teacher wondered about this, but Toby seemed so believable. Then Toby brought a little (Toby's words) knife. That led to a real understanding between the teacher and Toby's mother.

Toby does not go to school on the bus. He gets teased and then retaliates immediately. Since it is impossible to supervise bus rides adequately, his parents and the school gave up and they drive him to school. It is still hard to get him there on time. As the time to leave approaches, he gets slower and slower. Now it is not quite as bad because for every minute he is late he loses a dime from his daily allowance. Once at school, he usually gets into a little pushing with the other kids in those few minutes between his mother's eyes and the teacher's. The class work does not go that badly now. Between the daily allowance which is geared to behavior and his medicine, he manages alright. This is good for everyone. At the beginning of the school year he would flip desks, swear at the teacher, tear up his work and refuse to do most things. Looking back, the reasons seem so trivial. He was not allowed to go to the bathroom, so he flipped his desk. He was told to stop tapping his pencil, so he swore at the teacher.

Recess is still the hardest time. Toby tells everyone that he has lots of friends, but if you watch what goes on in the lunch room or on the playground, it is hard to figure out who they are. Some kids avoid him, but most would give him a chance if he wasn't so bossy. The playground supervisor tries to get him involved in a field hockey game every day. He isn't bad at it, but he will not pass the ball, so no one really wants him on his team.

After school was the time that made his mom seriously considered foster care. The home work battle was horrible. He would refuse to do work for an hour, then complain, break pencils and irritate her. This dragged 30 minutes of work out to two hours. So, now she hires a tutor. He doesn't try all of this on the tutor, at least so far. With no home work, he is easier to take. But he still wants to do something with her every minute. Each day he asks her to help him with a model or play a game at about 4:30. Each day she tells him she cannot right now as she is making supper. Each day he screams out that she doesn't ever do anything with him, slams the door, and goes in the other room and usually turns the TV on very loud. She comes up, tells him to turn it down three times. He doesn't and is sent to his room. She calculated that she has made about 1500 suppers since he was five years old. Could it be that they have gone through this 1500 times? She decides this is not a good thought to follow through. After supper Toby's dad takes over and they play some games together and usually it goes fine for about an hour. Then it usually ended in screaming. So Toby's grandmother had the bright idea of inviting them over for desert at about 8:00 pm most nights. But what about days when there is no school? Toby's parents try very hard not to think about that.

High School Courtney—

Courtney is 15. She is in ninth grade, and from her grades, you would say there is no big problem. She is passing everything, but her teachers always comment that she is capable of much more if she tried. If they gave marks for getting along with others, it would be a different story. Courtney's best friend is currently doing a 6 month sentence for vandalism and shoplifting. Courtney and Robin have been friends since fall, if you can call it that. Since Courtney has almost no other friends, she will do anything to be Robin’s friend. At least that is what her parents think. Courtney thinks it is "cool" that Robin is at the MCYC Youth Center. One sign of this friendship was that Courtney almost always gave her lunch money to Robin. Why? Because Robin wanted it. Courtney thought that Robin was her friend, but everyone could see that Robin was just using her. What seemed saddest to Courtney's parents is that Courtney could not see this at all. But this was nothing new. She would make a friend, smother them with attention, and that would be the end of it. Or, the friend would not do exactly what Courtney wanted and there would be a big fight, and it would be over. But mostly Courtney complained that everyone bugged her. What seemed to save Courtney was the nursing home. Somewhere along the way Courtney got involved working there. To hear the staff there talk about her, you would never guess it was the same girl. Helpful, kind, thoughtful - they couldn't say enough good about her. In fact her parents joked that maybe if they all moved to the nursing home, it would stop the fighting at home. They figured it out when another teenager volunteered to help one of the same afternoons as Courtney. Unfortunately the "other" Courtney came out. She was tattling, annoying, disrespectful and hard to get along with. Courtney could get along with any one, as long as they weren't her age, a teacher, or a relative!

These examples stress some of the common features of this comorbid combination. Extremely major social problems with relatively little academic problems are common. Recent research suggests that all things being equal, females with ODD plus ADHD have significantly worse social problems than males with ODD plus ADHD. Courtney in the example above illustrates this.

Oppositional Defiant Disorder is the most common psychiatrically diagnosed behavioral disorder in kids that usually persists into adulthood. Kids with OPPOSITIONAL DEFIANT DISORDER are often easily annoyed and deliberately annoying to other people. They repeatedly lose their temper, argue with adults, refuse to comply with rules and directions, and blame others for their mistakes. Stubbornness and testing limits are common, even in early childhood. They are often touchy, angry and resentful; spiteful and vindictive; speak harshly and unkind when upset, seek revenge and have frequent temper tantrums. They are manipulative and often induce discord in those around them. The primary behavioral difficulty however is their consistent pattern of refusing to follow the commands or requests by adults. Symptoms of OPPOSITIONAL DEFIANT DISORDER are usually seen in multiple settings, but may be more noticeable at home or at school.

All kids display most of these behaviors from time to time and oppositional behavior is often a normal part of development for the two to three year old and early adolescent. However, kids with OPPOSITIONAL DEFIANT DISORDER display these behaviors more frequently and over a long period of time (i.e. six months or more) and to the extent that these behaviors interfere with learning, school adjustment and sometimes social relationships.

Who Gets ODD?

Five to 15% percent of all school-age kids have OPPOSITIONAL DEFIANT DISORDER. In younger kids it is more common in boys than girls, but as they grow older, the rate is the same in males and females. Some kids with OPPOSITIONAL DEFIANT DISORDER may go on to develop the more serious Conduct Disorder (CD) which is characterized by aggressive, criminal and violent behaviors. Thus, OPPOSITIONAL DEFIANT DISORDER is sometimes a precursor of Conduct Disorder. And, although much of the literature tends to lump ODD and CD together, they seem to be distinct entities. Conduct disorder has a genetic component, OPPOSITIONAL DEFIANT DISORDER does not.

What Causes ODD?

The causes of OPPOSITIONAL DEFIANT DISORDER are unknown, but biological and environmental factors may have a role. The quality of the youngster's family life in particular seems to be an important factor in the development of OPPOSITIONAL DEFIANT DISORDER. Some studies have found that certain environmental factors in the family increase the risk of disruptive behavior disorders including: poor parenting skills, domestic violence, physical abuse, sexual abuse, neglect, poverty and substance abuse by parents or caregivers. Some students develop OPPOSITIONAL DEFIANT DISORDER as a result of stress and frustration from divorce, death or loss of a family member. OPPOSITIONAL DEFIANT DISORDER may also be a way of dealing with depression or the result of inconsistent rules and behavior standards.

Diagnosing ODD—

A youngster showing symptoms of OPPOSITIONAL DEFIANT DISORDER should have a comprehensive evaluation because the diagnosis of OPPOSITIONAL DEFIANT DISORDER is not always straight forward. Therefore it needs to be made by a psychiatrist or some other qualified mental health professional after a comprehensive evaluation. The youngster must be evaluated for other disorders as well since OPPOSITIONAL DEFIANT DISORDER usually does not exist alone. OPPOSITIONAL DEFIANT DISORDER commonly occurs in conjunction with anxiety disorders and depressive disorders. Fifty to sixty-five percent of kids with OPPOSITIONAL DEFIANT DISORDER have ADHD, 35% develop some form of affective disorder, 20% have some form of mood disorder such as depression or anxiety and 15% develop some form of personality disorder. If the youngster has ADHD, mood disorders, or anxiety disorders, these other problems must be addressed before you can begin to work with the Oppositional Defiant Disorder component. It will be difficult to improve the symptoms of OPPOSITIONAL DEFIANT DISORDER without treating the coexisting disorder.

Treating ODD—

The treatment of OPPOSITIONAL DEFIANT DISORDER may include: Parent Training Programs to help manage the youngster's behavior, Individual Psychotherapy to develop more effective anger management, Family Psychotherapy to improve communication, Cognitive-Behavioral Therapy to assist problem solving and decrease negativity, and Social Skills Training to increase flexibility and improve frustration tolerance. However, below are suggested behavioral and instructional classroom strategies that can be used for kids with OPPOSITIONAL DEFIANT DISORDER.

Behavioral Strategies and Approaches for Kids with ODD—

Getting a reaction out of others is the chief hobby of kids with OPPOSITIONAL DEFIANT DISORDER. They like to see you get mad. They try to provoke reactions in people and are often successful in creating power struggles. Therefore it is important to have a plan and try not to show any emotion when reacting to them. If you react too emotionally, you may make big mistakes in dealing with this youngster. Plan in advance what to do when this student engages in certain behaviors and be prepared to follow through calmly.

• Address concerns privately. This will help to avoid power struggles as well as an audience for a potential power struggle.• Always listen to this student. Let him/her talk. Don't interrupt until he/she finishes.• Ask parents what works at home.• Avoid all power struggles with this student. They will get you nowhere. Thus, try to avoid verbal exchanges. State your position clearly and concisely and choose your battles wisely.• Avoid making comments or bringing up situations that may be a source of argument for them.• Decide which behaviors you are going to ignore. Most kids with OPPOSITIONAL DEFIANT DISORDER are doing too many things you dislike to include all of them in a behavior management plan. Thus, target only a few important behaviors, rather than trying to fix everything.• Do not take the defiance personally. Remember, you are the outlet and not the cause for the defiance- unless you are shouting, arguing or attempting to handle the student with sarcasm.• Establish a rapport with the OPPOSITIONAL DEFIANT DISORDER youngster. If this youngster perceives you as reasonable and fair, you'll be able to work more effectively with him or her.• Give the OPPOSITIONAL DEFIANT DISORDER student some classroom responsibilities. This will help him/her to feel apart of the class and some sense of controlled power. If he/she abuses the situation, the classroom responsibilities can be earned privileges.• In the private conference be caring but honest. Tell the student calmly what it is that is causing problems as far as you are concerned. Be sure you listen as well. In this process, insist upon one rule- that you both be respectful.• Make this student a part of any plan to change behavior. If you don't, you'll become the enemy.• Never raise your voice or argue with this student. Regardless of the situation do not get into a "yes you will" contest. Silence is a better response.• Praise students when they respond positively.• Provide consistency, structure, and clear consequences for the student’s behavior.• When decisions are needed, give two choices or options. State them briefly and clearly. Students with OPPOSITIONAL DEFIANT DISORDER are more likely to complete or perform tasks that they have chosen. This also empowers them to make other decisions.• When you see an OPPOSITIONAL DEFIANT DISORDER youngster getting frustrated or angry, ask if a calming down period would help. But don't force it on him/her. Rather than sending the student down to the office for this cooling down period, it may be better to establish an isolated “calming down” place in the classroom so he/she can more readily re-engaged in classroom activity following the cooling down period.

Instructional Strategies and Classroom Accommodations for the ODD Student—

• Allow the OPPOSITIONAL DEFIANT DISORDER student to redo assignments to improve their score or final grade.• Establish clear classroom rules. Be clear about what is nonnegotiable.• Make sure academic work is at the appropriate level. When work is too hard, students become frustrated. When it is too easy, they become bored. Both reactions lead to problems in the classroom.• Minimize downtime and plan transitions carefully. Students with OPPOSITIONAL DEFIANT DISORDER do best when kept busy.• Pace instruction. When the student with OPPOSITIONAL DEFIANT DISORDER completes a designated amount of a non-preferred activity, reinforce his/her cooperation by allowing him/her to do something they prefer or find more enjoyable or less difficult.• Post the daily schedule so the student will know what to expect.• Select materials that encourage student interaction. Students with OPPOSITIONAL DEFIANT DISORDER need to learn to talk to their peers and to adults in an appropriate manner. All cooperative learning activities must be carefully structured, however.• Structure activities so the student with OPPOSITIONAL DEFIANT DISORDER is not always left out or is the last person picked.• Systematically teach social skills, including anger management, conflict resolution and how to be assertive in an appropriate manner. Discuss strategies that the student may use to calm him/ or herself down when they feel their anger escalating. Do this when the student is calm.

1. Communicate your displeasure with a student's misbehavior, but then be sure to tell the student what s/he should be doing. For example, consider: "Bill, please put the pencil down on the desk and pass your paper forward." Notice that the teacher told the student what to do. Often students continue to display inappropriate behavior when they have been told to discontinue it because they do not know what they should be doing. Now that you have given a direction, you can reinforce the student for compliance or punish him or her for noncompliance. Be sure to add emphasis to your directions by using eye contact, hand gestures, and the student's name.

2. Conduct a meeting to inform the students of the classroom rules. Explain why rules are needed. List the rules on the board along with the positive and negative consequences. Check for understanding. Review periodically throughout the year (especially soon after implementation of the program) in order to reiterate important points and consolidate the program.

3. Decide which rules you wish to implement in your classroom. Devise four or five rules that are specific and easily understood by your students.

4. Determine negative consequences for noncompliance (you will be providing a consequence EVERY TIME a student misbehaves). Choose three to six negative consequences (a "discipline hierarchy"), each of which is more punitive or restrictive than the previous one. These will be administered if the student continues to misbehave.

5. Determine positive consequences for appropriate behavior. For example, along with verbal praise, you might also include raffle tickets that are given to students for proper behavior. Students write their names on the cut up pieces of paper and drop them into a container for a daily prize drawing. Even if a student is having a bad day, there is a reason to improve...s/he might get a ticket and have a chance at winning the raffle prize. Others might receive notes of praise to be shown to their parents. Group rewards are also used. A marble might be dropped into a jar for each predetermined interval that the class as a whole has been attentive and respectful. When the jar is full, a special event is held. Some assertive teachers write a letter of the alphabet on the board for each period/activity of good group behavior. When the letters spell "Popcorn Party" (or some other activity), that event is held.

6. Dismiss the thought that there is any acceptable reason for misbehavior (biologically based misbehavior may be an exception).

7. Have the students write the classroom rules and take them home to be signed by the parents/guardians and returned (optional depending on age of students, chances of forms being reviewed and returned, etc.). Attach a message explaining the rules and requesting their help.

8. If kids don't presently possess desired classroom behaviors, teach them! This instruction involves more than just giving commands. Teach and role-play actions in order to promote responsible behavior.

9. Learn to use the "broken record" technique. Continue to repeat your command (a maximum of three times) until the student follows your directions. If directions are not followed at that point, the sequential list of penalties is implemented. Do not be sidetracked by the student's excuses. If the command is not followed, you might issue a choice to the student. This can be done after the first, second, or third request. Give the student a choice between following the command or facing a consequence for disobedience. If you find it necessary to implement the consequence, make it clear to the student that s/he made the decision as to which option would occur. The consequence should be administered quickly and in a calm, matter-of-fact manner. In the above situation, you would move through your list of negative consequences until the student complies.

10. Learn to use the "positive repetitions" technique. This is a disguised way of repeating your rules so that all students know what to do. Repeat the directions as positive statements to students who are complying with your commands (e.g. "Jason raised his hand to be recognized. So did Harold and Cynthia. Thanks you.").

11. Make use of proximity control; moving toward misbehaving students. Invite adolescents into the hallway to "talk" to avoid embarrassment in front of peers (and the negative behavior that will most likely result if you engage in public chastisement).

12. Recognize and quickly respond to appropriate behavior. This quick action will encourage the students to display the desired behavior more often. Be aware that some students may need to be reinforced quietly or non-verbally to prevent embarrassment in front of peers.

13. Use "proximity praise". Instead of just focusing on the misbehaving students, praise youngsters near them who are doing the correct thing. It is hoped that the misbehaving students will then model that appropriate behavior. The comments can be made specific and obvious for younger students. More subtle recognition is required for adolescents.

Although professionals in the field hold a variety of philosophical beliefs, they generally agree that there is no single cause for problem behaviors. The following examples illustrate some of the underlying causes for "acting-out" behavior:

John, a 16 year old who reads at a second grade level, feels embarrassed to be seen with an elementary text and reacts by throwing his reading book across the room and using inappropriate language to inform the teacher that he does not intend to complete his homework.

Reggie, an eight year old who reads Stephen King novels for recreation, finds her reading assignments boring and, therefore, shoves her book and workbook to the floor when the teacher comments on her lack of progress.

Michael, a 10 year old who finds multiplication of fractions difficult, becomes frustrated and throws tantrums when asked to complete worksheets requiring him to multiply fractions; and

James, a 12 year old who has problems paying attention, is so over stimulated by what she sees out of the window and hears in the nearby reading group, she slams her text shut and loudly declares that she cannot work.

A conclusion gleaned from these examples may be that, although the topography (what the behavior looks like or sounds like) of the behaviors may be similar, in each case, the "causes," or functions, of the behaviors are very different. Thus, focusing only on the topography will usually yield little information about effective interventions. Identifying the underlying cause(s) of a child’s behavior, however, or, more specifically, what the child "gets" or "avoids" through the behavior, can provide the INDIVIDUALIZED EDUCATION PROGRAM team with the diagnostic information necessary to develop proactive instructional strategies (such as positive behavioral interventions and supports) that are crafted to address behaviors that interfere with academic instruction.

To illustrate this point, again consider the acting-out behaviors previously described. Reactive procedures, such as suspending each child as a punishment for acting-out, will only address the symptoms of the problem, and will not eliminate the embarrassment John feels, Reggie’s boredom, the frustration that Michael is experiencing, or James’s overstimulation. Therefore, each of these behaviors is likely to occur again, regardless of punishment, unless the underlying causes are addressed.

Functional behavioral assessment is an approach that incorporates a variety of techniques and strategies to diagnose the causes and to identify likely interventions intended to address problem behaviors. In other words, functional behavioral assessment looks beyond the overt topography of the behavior, and focuses, instead, upon identifying biological, social, affective, and environmental factors that initiate, sustain, or end the behavior in question. This approach is important because it leads the observer beyond the "symptom" (the behavior) to the child’s underlying motivation to escape, "avoid," or "get" something (which is, to the functional analyst, the root of all behavior). Research and experience has demonstrated that behavior intervention plans stemming from the knowledge of why a child misbehaves (i.e., based on a functional behavioral assessment) are extremely useful in addressing a wide range of problems.

The functions of behavior are not usually considered inappropriate. Rather, it is the behavior itself that is judged appropriate or inappropriate. For example, getting high grades and acting-out may serve the same function (i.e., getting attention from adults), yet, the behaviors that lead to good grades are judged to be more appropriate than those that make up acting-out behavior. For example, if the INDIVIDUALIZED EDUCATION PROGRAM team determines through a functional behavioral assessment that a child is seeking attention by acting-out, they can develop a plan to teach the child more appropriate ways to gain attention, thereby filling the child’s need for attention with an alternative behavior that serves the same function as the inappropriate behavior.

By incorporating functional behavioral assessment into the INDIVIDUALIZED EDUCATION PROGRAM process, the INDIVIDUALIZED EDUCATION PROGRAM team can gain the information needed to develop a plan or include strategies in the INDIVIDUALIZED EDUCATION PROGRAM, and INDIVIDUALIZED EDUCATION PROGRAM team members can develop a plan that teaches and supports replacement behaviors, which serve the same function as the problem behavior, itself (e.g., teaching Michael to calmly tell the teacher when he feels frustrated, and to ask for assistance when he finds a task too difficult to accomplish). At the same time, strategies may be developed to decrease or even eliminate opportunities for the child to engage in behavior that hinders positive academic results (e.g., making sure that Michael’s assignments are at his instructional level).

Conducting a Functional Behavioral Assessment—

Identifying the underlying causes of behavior may take many forms; and, while the Amendments to IDEA advice a functional behavioral assessment approach (which could determine specific contributors to behavior); they do not require or suggest specific techniques or strategies to use when assessing that behavior. While there are a variety of techniques available to conduct a functional behavioral assessment, the first step in the process is to define the behavior in concrete terms. In the following section we will discuss techniques to define behavior.

Identifying the Problem Behavior—

Before a functional behavioral assessment can be implemented, it is necessary to pinpoint the behavior causing learning or discipline problems, and to define that behavior in concrete terms that are easy to communicate and simple to measure and record. If descriptions of behaviors are vague (e.g., poor attitude), it is difficult to determine appropriate interventions. Examples of concrete descriptions of problem behaviors are:

Problem Behavior / Concrete Definition—

• Jonnie is aggressive. / Jonnie hits other children during recess when she does not get her way.• Craig is disruptive. / Craig makes irrelevant and inappropriate comments during class discussion.• Sammy is hyperactive. / Sammy leaves her assigned area without permission, completes only small portions of her independent work, and blurts out answers without raising her hand.

It may be necessary to carefully and objectively observe the child’s behavior in different settings and during different types of activities, and to conduct interviews with other school staff and caregivers, in order to pinpoint the specific characteristics of the behavior.

Once the problem behavior has been defined concretely, the team can begin to devise a plan for conducting a functional behavioral assessment to determine functions of the behavior. The following discussion can be used to guide teams in choosing the most effective techniques to determine the likely causes of behavior.

Possible Alternative Assessment Strategies—

The use of a variety of assessment techniques will lead teams to better understand child behavior. Each technique can, in effect, bring the team closer to developing a workable intervention plan.

A well developed assessment plan and a properly executed functional behavioral assessment should identify the contextual factors that contribute to behavior. Determining the specific contextual factors for a behavior is accomplished by collecting information on the various conditions under which a child is most and least likely to be a successful learner. That information collected both indirectly and directly, allows school personnel to predict the circumstances under which the problem behavior is likely and not likely to occur.

Multiple sources and methods are used for this kind of assessment, as a single source of information generally does not produce sufficiently accurate information, especially if the problem behavior serves several functions that vary according to circumstance (e.g., making inappropriate comments during lectures may serve to get peer attention in some instances, while in other situations it may serve to avoid the possibility of being called on by the teacher).

It is important to understand, though, that contextual factors are more than the sum of observable behaviors, and include certain affective and cognitive behaviors, as well. In other words, the trigger, or antecedent for the behavior, may not be something that anyone else can directly observe, and, therefore, must be identified using indirect measures. For instance, if the child acts out when given a worksheet, it may not be the worksheet that caused the acting-out, but the fact that the child does not know what is required and thus anticipates failure or ridicule. Information of this type may be gleaned through a discussion with the child.

Since problem behavior stems from a variety of causes, it is best to examine the behavior from as many different angles as possible. Teams, for instance, should consider what the "pay-off" for engaging in either inappropriate or appropriate behavior is, or what the child "escapes," "avoids," or "gets" by engaging in the behavior. This process should identify workable techniques for developing and conducting functional behavioral assessments and developing behavior interventions. When considering problem behaviors, teams might ask the following questions.

Is the problem behavior linked to a skill deficit?

Is there evidence to suggest that the child does not know how to perform the skill and, therefore cannot? Children who lack the skills to perform expected tasks may exhibit behaviors that help them avoid or escape those tasks. If the team suspects that the child "can’t" perform the skills, or has a skill deficit, they could devise a functional behavioral assessment plan to determine the answers to further questions, such as the following:

• Does the child have the skills necessary to perform expected, new behaviors?• Does the child realize that he or she is engaging in unacceptable behavior, or has that behavior simply become a "habit"?• Does the child understand the behavioral expectations for the situation?• Is it within the child’s power to control the behavior, or does he or she need support?

Does the child have the skill, but, for some reason, not the desire to modify his or her behavior?

Sometimes it may be that the child can perform a skill, but, for some reason, does not use it consistently (e.g., in particular settings). This situation is often referred to as a "performance deficit." Children who can, but do not perform certain tasks may be experiencing consequences that affect their performance (e.g., their non-performance is rewarded by peer or teacher attention, or performance of the task is not sufficiently rewarding). If the team suspects that the problem is a result of a performance deficit, it may be helpful to devise an assessment plan that addresses questions such as the following:

• Does the child find any value in engaging in appropriate behavior?• Is it possible that the child is uncertain about the appropriateness of the behavior (e.g., it is appropriate to clap loudly and yell during sporting events, yet these behaviors are often inappropriate when playing academic games in the classroom)?• Is the behavior problem associated with certain social or environmental conditions?o Is the child attempting to avoid a "low-interest" or demanding task?o What current rules, routines, or expectations does the child consider irrelevant?

Addressing such questions will assist the INDIVIDUALIZED EDUCATION PROGRAM team in determining the necessary components of the assessment plan, and ultimately will lead to more effective behavior intervention plans. Some techniques that could be considered when developing a functional behavioral assessment plan are discussed in the following section.

Techniques for Conducting the Functional Behavioral Assessment—

Indirect assessment. Indirect or informant assessment relies heavily upon the use of structured interviews with students, educators, and other adults who have direct responsibility for the children concerned. Individuals should structure the interview so that it yields information regarding the questions discussed in the previous section, such as:

• Are there any settings where the behavior does not occur?• Can you think of a more acceptable behavior that might replace this behavior?• In what settings do you observe the behavior?• What activities or interactions take place just prior to the behavior?• What usually happens immediately after the behavior?• Who is present when the behavior occurs?

Interviews with the child may be useful in identifying how he or she perceived the situation and what caused her or him to react or act in the way they did. Examples of questions that one may ask include:

• Can you tell me how Mr. Smith expects you to contribute to class lectures?• How did the assignment make you feel?• What were you thinking just before you threw the textbook?• When you have a "temper tantrum" in class, what usually happens afterward?

Commercially available student questionnaires, motivational scales, and checklists can also be used to structure indirect assessments of behavior. The district’s school psychologist or other qualified personnel can be a valuable source of information regarding the feasibility of using these instruments.

Direct assessment. Direct assessment involves observing and recording situational factors surrounding a problem behavior (e.g., antecedent and consequent events). An evaluator may observe the behavior in the setting that it is likely to occur, and record data using an Antecedent-Behavior-Consequence (ABC) approach. (Appendix A shows two examples of an ABC recording sheet.)

The observer also may choose to use a matrix or scatter plot to chart the relationship between specific instructional variables and student responses. (See Appendix B for examples). These techniques also will be useful in identifying possible environmental factors (e.g., seating arrangements), activities (e.g., independent work), or temporal factors (e.g., mornings) that may influence the behavior. These tools can be developed specifically to address the type of variable in question, and can be customized to analyze specific behaviors and situations (e.g., increments of 5 minutes, 30 minutes, 1 hour, or even a few days). Regardless of the tool, observations that occur consistently across time and situations, and that reflect both quantitative and qualitative measures of the behavior in question, are recommended.

Data analysis. Once the team is satisfied that enough data have been collected, the next step is to compare and analyze the information. This analysis will help the team to determine whether or not there are any patterns associated with the behavior (e.g., whenever Jane does not get her way, she reacts by hitting someone). If patterns cannot be determined, the team should review and revise (as necessary) the functional behavioral assessment plan to identify other methods for assessing behavior.

Hypothesis statement. Drawing upon information that emerges from the analysis, school personnel can establish a hypothesis regarding the function of the behaviors in question. This hypothesis predicts the general conditions under which the behavior is most and least likely to occur (antecedents), as well as the probable consequences that serve to maintain it. For instance, should a teacher report that Lucia calls out during instruction, a functional behavioral assessment might reveal the function of the behavior is to gain attention (e.g., verbal approval of classmates), avoid instruction (e.g., difficult assignment), seek excitement (i.e., external stimulation), or both to gain attention and avoid a low-interest subject.

Only when the relevance of the behavior is known is it possible to speculate the true function of the behavior and establish an individual behavior intervention plan. In other words, before any plan is set in motion, the team needs to formulate a plausible explanation (hypothesis) for the child’s behavior. It is then desirable to manipulate various conditions to verify the assumptions made by the team regarding the function of the behavior. For instance, the team working with Lucia in the example above may hypothesize that during class discussions, Lucia calls out to get peer attention. Thus, the teacher might make accommodations in the environment to ensure that Lucia gets the peer attention she seeks as a consequence of appropriate, rather than inappropriate behaviors. If this manipulation changes Lucia’s behavior, the team can assume their hypothesis was correct; if Lucia’s behavior remains unchanged following the environmental manipulation, a new hypothesis needs to be formulated using data collected during the functional behavioral assessment.

Many products are available commercially to help INDIVIDUALIZED EDUCATION PROGRAM teams to assess behaviors in order to determine their function. Sources for more information about techniques, strategies, and tools for assessing behavior are presented in the last section of this discussion.

Individuals Assessing Behavior—

Persons responsible for conducting the functional behavioral assessment will vary from state to state and possibly from district to district. Some behavioral assessment procedures, such as standardized tests, may require an individual with specific training (e.g., behavior specialist or school psychologist). With specialized training, experience, and support, however, many components of the assessment can be conducted by other individuals, such as special or general education educators, counselors, and administrators. Again, it is important to note that interventions should not be based upon one assessment measure, alone, or upon data collected by only one observer.

Behavior Intervention Plans—

After collecting data on a child’s behavior, and after developing a hypothesis of the likely function of that behavior, a team develops (or revises) the child’s behavior intervention plan or strategies in the INDIVIDUALIZED EDUCATION PROGRAM. These may include positive strategies, program or curricular modifications, and supplementary aids and supports required to address the disruptive behaviors in question. It is helpful to use the data collected during the functional behavioral assessment to develop the plan and to determine the discrepancy between the youngster’s actual and expected behavior.

The input of the general education teacher, as appropriate (i.e., if the child is, or may be participating in the regular education environment), is especially crucial at this point. He or she will be able to relay to the team not only his or her behavioral expectations, but also valuable information about how the existing classroom environment and/or general education curriculum can be modified to support the child.

Intervention plans and strategies emphasizing skills children need in order to behave in a more appropriate manner, or plans providing motivation to conform to required standards, will be more effective than plans that simply serve to control behavior. Interventions based upon control often fail to generalize (i.e., continue to be used for long periods of time, in many settings, and in a variety of situations) — and many times they serve only to suppress behavior — resulting in a youngster manifesting unaddressed needs in alternative, inappropriate ways. Positive plans for behavioral intervention, on the other hand, will address both the source of the problem and the problem itself.

INDIVIDUALIZED EDUCATION PROGRAM teams may want to consider the following techniques when designing behavior intervention plans, strategies, and supports:

• Implement changes in curriculum and instructional strategies• Manipulate the antecedents and/or consequences of the behavior• Modify the physical environment• Teach more acceptable replacement behaviors that serve the same function as the inappropriate behavior

The following section describes some ideas INDIVIDUALIZED EDUCATION PROGRAM teams may consider when developing behavior intervention plans and strategies.

Addressing Skill Deficits—

An assessment might indicate the child has a skill deficit, and does not know how to perform desired skills. The functional behavioral assessment may show that, although ineffective, the youngster may engage in the inappropriate behavior to escape or avoid a situation: (1) for which he or she lacks the appropriate skills; or (2) because she or he lacks appropriate, alternative skills and truly believes this behavior is effective in getting what he or she wants or needs. For example, a youngster may engage in physically violent behavior because he or she believes violence is necessary to efficiently end the confrontational situation, and may believe that these behaviors will effectively accomplish his or her goals. However, when taught to use appropriate problem-solving techniques, the child will be more likely to approach potentially volatile situations in a nonviolent manner. If this is the case, the intervention may address that deficit by including, within the larger plan, a description of how to teach the problem-solving skills needed to support the youngster.

If the child does not know what the behavioral expectations are, the plan can be formulated to teach expectations, and would include the supports, aids, strategies, and modifications necessary to accomplish this instruction, with expectations explained in concrete terms. For example, if the expectation is "to listen to lectures," the intervention plan might include the following:

• Goal: During classroom lectures, Andrew will make only relevant comments and ask only relevant questions in 80 percent of the opportunities.

• Objectives: Given a 50 minute, large group (i.e., more than 20 students) classroom lecture, Andrew will ask one appropriate question and make two relevant comments on each of 3 consecutive school days.

Activities to accomplish the goal and objectives:

• Andrew will identify and use active listening skills in situations other than class lectures.• Andrew will list the situations in which active listening skills are important and will describe the necessary behaviors in each of those situations;• Andrew will monitor the opportunity and degree to which he actively listens during lectures and will reinforce himself (e.g., "I did a great job!"); and• Andrew will participate in "role-plays" of situations in which active listening skills are necessary;• Andrew will practice active listening in each of the situations listed above — and will report the results to his teacher, counselor, or parent;• The teacher will model examples and non-examples of situations when listening is important and assist Andrew in identifying the components of active listening (e.g., hands and feet still, eyes facing the speaker, quiet lips, think about what is being said and determine if you need more information, think about how the information makes you feel, and if necessary, make a comment or ask a question);

If the child does not realize that he or she is engaging in the behavior, (i.e., the child is reacting out of habit), the team may devise a plan to cue the youngster when she or he is so engaged. Such a cue could be private and understood only by the teacher and the child. If Martha, for instance, impulsively talks out during Ms. Bader’s class discussions, Ms. Bader and Martha may agree that Ms. Bader will look directly at Martha and slightly move her right hand in an upward motion to remind Martha to raise her hand. If Martha does raise her hand, Ms. Bader agrees to call on her.

Sometimes, for biological or other reasons, a child is unable to control his or her behavior without supports. If the INDIVIDUALIZED EDUCATION PROGRAM team believes the child needs medical services for diagnostic and evaluation purposes an appropriate referral can be made.

Should the child not know how to perform the expected behaviors, the intervention plan could include modifications and supports to teach the youngster the needed skills. Such instruction may require teaching academic skills as well as behavioral and cognitive skills, and may require a team member to do a task analysis (i.e., break down a skill into its component parts) of the individual behaviors that make up the skill. For example, if the skill is to "think through and solve social problems," the individual skills may include:

• Define the problem (What is the goal? What is the obstacle?);• List the possible solutions to the problem;• Determine the likely consequences of each solution;• Evaluate each solution to determine which solution has the best likelihood of solving the problem in the long term;• Pick the best solution;• Plan how to carry out the solution;• Carry out the solution; and• Evaluate the effectiveness of the solution (and decide where to go from there).

The behavior intervention plan, in the previous case, would include methods to teach the necessary skills to the youngster, and would provide the supports necessary to accomplish such plans. Methods may include the following components:

• Identify the steps necessary to solve social problems;• Recognize the steps to solve social problems when they are modeled by a teacher or a peer;• Participate in role-play situations requiring the use of the social problem solving skills; and• Practice social problem solving in real-life situations.

A technique known as curricular integration is useful in teaching skills to children, as the technique integrates positive strategies for modifying problem behavior into the existing classroom curriculum, and is based upon the premise that a skill is more likely to be learned when taught in the context in which it is used. Educators who incorporate behavioral interventions into daily instruction generally state that this technique has proven to be particularly effective for teaching replacement behaviors.

Addressing Performance Deficits—

If the functional behavioral assessment reveals that the child knows the skills necessary to perform the behavior, but does not consistently use them, the intervention plan may include techniques, strategies, and supports designed to increase motivation to perform the skills.

If the assessment reveals that the child is engaging in the problem behavior because it is more desirable (or reinforcing) than the alternative, appropriate behavior, the intervention plan could include techniques for making the appropriate behavior more desirable. For instance, if the child makes rude comments in class in order to make her peers laugh, the plan might include strategies for rewarding appropriate comments as well as teaching the child appropriate ways to gain peer attention. Behavioral contracts or token economies and other interventions that include peer and family support may be necessary in order to change the behavior.

Sometimes a youngster does not perform the behavior simply because he or she sees no value in it. While the relevance of much of what we expect children to learn in school is apparent to most kids, sometimes (especially with older kids) it is not. For example, if Sheran wants to be a hairdresser when she graduates, she may not see any value in learning about the Battle of Waterloo. Therefore, the intervention plan may include strategies to increase her motivation, such as demonstrating to Sheran that she must pass History in order to graduate and be accepted into the beauty school program at the local community college.

Another technique for working with children who lack intrinsic motivators is to provide extrinsic motivators. If the child cannot see any intrinsic value in performing the expected behaviors, it may be necessary to, at least initially, reinforce the behaviors with some type of extrinsic reward, such as food, activities, toys, tokens, or free time. Of course, extrinsic rewards should gradually be replaced with more "naturally occurring" rewards, such as good grades, approval from others, or the sheer pleasure that comes from success. This process of fading out, or gradually replacing extrinsic rewards with more natural or intrinsic rewards, may be facilitated by pairing the extrinsic reward with an intrinsic reward. For example, when rewarding David with popcorn for completing his homework, the paraprofessional could say, David, you have completed all of your homework this week, and your class participation has increased because you are better prepared. You must be very proud of yourself for the hard work you have done. In this way, David should eventually become intrinsically rewarded by a sense of pride in completing all of his assignments.

Addressing Both Skill and Performance Deficits—

Some student problems are so severe they require a combination of techniques and supports. For example, if the child finds it difficult to control his or her anger, she or he may need to be taught certain skills, including the following:

• recognize the physical signs that he or she is becoming angry,• use relaxation skills,• apply problem-solving skills, and• practice communication skills.

...and have the added support of:

• the school counselor,• the school psychologist, and• curricular or environmental modifications.

In addition, the child may need to be provided with external rewards for appropriately dealing with anger.

Many professionals and professional organizations agree that it is usually ineffective and often unethical to use aversive techniques to control behaviors, except in very extreme cases, such as situations in which:

• every possible positive intervention has been tried for an appropriate length of time and found ineffective• the behavior of the child severely limits his or her learning or socialization, or that of others• the youngster’s behavior severely endangers her or his safety or the safety of others

It is important for INDIVIDUALIZED EDUCATION PROGRAM teams to consider all positive interventions before they consider punishment as an option. Punishment often makes behavior worse. Further, punishment seeks to control the symptom of the problem and does not address the function of the behavior.

Modifying the Learning Environment—

In addition to factors of skill and motivation, the functional behavioral assessment may reveal conditions within the learning environment, itself, that may precipitate problem behavior. Factors that can serve as precursors to misbehavior range from the physical arrangement of the classroom or student seating assignment to academic tasks that are "too demanding" or "too boring." Again, simple curricular or environmental modifications may be enough to eliminate such problems.

Providing Supports—

Sometimes supports are necessary to help children use appropriate behavior. The child, for example, may benefit from work with school personnel, such as counselors or school psychologists. Other people who may provide sources of support include:

• Families, who may provide support through setting up a home work center in the home and developing a home work schedule• Language pathologists, who are able to increase a youngster’s expressive and receptive language skills, thereby providing the youngster with alternative ways to respond to any situation• Peers, who may provide academic or behavioral support through tutoring or conflict-resolution activities, thereby fulfilling the child’s need for attention in appropriate ways• Educators and paraprofessionals, who may provide both academic supports and curricular modifications to address and decrease a child’s need to avoid academically challenging situations

In addition, a variety of adults and students in and around the school and community may contribute support. An example of how one Local Education Agency helped a child use some of his energy in an appropriate manner involved allowing the child to work with the school custodian, contingent upon his completing his academic work each day.

Whatever the approach, the more proactive and inclusive the behavior intervention plan – and the more closely it reflects the results of the functional behavioral assessment – the more likely that it will succeed. In brief, one’s options for positive behavioral interventions may include:

• Increasing rates of existing appropriate behaviors• Making changes to the environment that eliminate the possibility of engaging in inappropriate behavior• Providing the supports necessary for the youngster to use the appropriate behaviors• Replacing problem behaviors with appropriate behaviors that serve the same (or similar) function as inappropriate ones

Care should be given to select a behavior that likely will be elicited by and reinforced in the natural environment, for example, using appropriate problem-solving skills on the playground will help the child stay out of the principal’s office.

Evaluating the Behavior Intervention Plan—

It is good practice for INDIVIDUALIZED EDUCATION PROGRAM teams to include two evaluation procedures in an intervention plan: one procedure designed to monitor the faithfulness with which the management plan is implemented, the other designed to measure changes in behavior. If a child already has a behavior intervention plan, the INDIVIDUALIZED EDUCATION PROGRAM team may elect to review the plan and modify it, or they may determine that more information is necessary and that a functional behavioral assessment is needed.

The Amendments to the IDEA require the INDIVIDUALIZED EDUCATION PROGRAM team "in the case of a youngster whose behavior impedes his or her learning or that of others, consider, when appropriate, strategies, including positive behavior interventions, strategies, and supports to address that behavior" (614(d)(3)(B)(i). To be meaningful, plans need to be reviewed at least annually and revised as appropriate. However, the plan may be reviewed and reevaluated whenever any member of the youngster’s INDIVIDUALIZED EDUCATION PROGRAM team feels that a review is necessary. Circumstances that may warrant such a review include:

• The youngster has reached his or her behavioral goals and objectives, and new goals and objectives need to be established;• The "situation" has changed and the behavioral interventions no longer address the current needs of the child;• The INDIVIDUALIZED EDUCATION PROGRAM team makes a change in placement; and• It is clear that the original behavior intervention plan is not bringing about positive changes in the child’s behavior.

The point is to predicate all evaluation on student success.

Summary—

The practice of conducting functional behavioral assessments of behavior that interferes with positive child outcomes allows INDIVIDUALIZED EDUCATION PROGRAM teams to develop more effective and efficient behavior intervention plans. Emphasis should be on enlarging child capacity to profit from instruction, which can be accomplished by designing pupil-specific interventions that not only discourage inappropriate behaviors, but teach alternative behaviors, and provide the child with the opportunity and motivation to engage in that behavior. If done correctly, the net result of behavioral assessments is that school personnel are better able to provide an educational environment that addresses the learning needs of all children.

Rambling -- wandering around and off the subject. Using far-fetched examples or analogies.

POSSIBLE RESPONSES:

o Ask how topic relates to current topic being discussed.
o Direct questions to group that is back on the subject
o Refocus attention by restating relevant point.
o Say: "Would you summarize your main point please?" or "Are you asking...?"
o Use visual aids, begin to write on board, turn on overhead projector.

2. BEHAVIOR:

Shyness or Silence -- lack of participation.

POSSIBLE RESPONSES:

o Appoint to be small group leader.
o Change teaching strategies from group discussion to individual written exercises or a videotape
o Give strong positive reinforcement for any contribution.
o Involve by directly asking him/her a question.
o Make eye contact.

3. BEHAVIOR:

Talkativeness -- knowing everything, manipulation, chronic whining.

POSSIBLE RESPONSES:

o Acknowledge comments made.
o Give limited time to express viewpoint or feelings, and then move on.
o Give the person individual attention during breaks.
o Make eye contact with another participant and move toward that person.
o Say: "That's an interesting point. Now let's see what other other people think."

4. BEHAVIOR:

Sharpshooting -- trying to shoot you down or trip you up.

POSSIBLE RESPONSES:

o Acknowledge that this is a joint learning experience.
o Admit that you do not know the answer and redirect the question the group or the individual who asked it.
o Ignore the behavior.

5. BEHAVIOR:

Heckling/Arguing -- disagreeing with everything you say; making personal attacks.

Grandstanding -- getting caught up in one's own agenda or thoughts to the detriment of other learners.

POSSIBLE RESPONSES:

o Say: "You are entitled to your opinion, belief or feelings, but now it's time we moved on to the next subject," or "Can you restate that as a question?" or "We'd like to hear more about that if there is time after the presentation."

7. BEHAVIOR:

Overt Hostility/Resistance -- angry, belligerent, combative behavior.

POSSIBLE RESPONSES:

o Allow individual to solve the problem being addressed. He or she may not be able to offer solutions and will sometimes undermine his or her own position.
o Always allow him or her a way to gracefully retreat from the confrontation.
o As a last resort, privately ask the individual to leave class for the good of the group.
o Do not accept the premise or underlying assumption, if it is false or prejudicial, e.g., "If by "queer" you mean homosexual..."
o Don't disagree, but build on or around what has been said.
o Hostility can be a mask for fear. Reframe hostility as fear to depersonalize it.
o Ignore behavior.
o Move closer to the hostile person, maintain eye contact.
o Remain calm and polite. Keep your temper in check.
o Respond to fear, not hostility.
o Say: "You seem really angry. Does anyone else feel this way?" Solicit peer pressure.
o Talk to him or her privately during a break.

Side Conversations -- may be related to subject or personal. Distracts group members and you.

POSSIBLE RESPONSES:

o Ask talkers if they would like to share their ideas.
o Ask their opinion on topic being discussed.
o Casually move toward those talking.
o Comment on the group (but don't look at them "one-at-a-time").
o Don't embarrass talkers.
o Make eye contact with them.
o Standing near the talkers, ask a near-by participant a question so that the new discussion is near the talkers.
o As a last resort, stop and wait.

KEYS FOR MANAGING CHALLENGING STUDENT BEHAVIORS—

• Allow children to save face. When we put children down in front of others, the entire class of children will turn against us.
• Do all you can to feel good about yourself and others on a daily basis. Your attitude will come across to your children, so it is important to be in good mental and physical shape.
• If, by chance, you feel that you have spoken sharply in an attempt to manager your children, own up to it. "Wow, that sounded harsh. Forgive me!"
• Instead of holding your children with an iron grip, allow them to be themselves until (and unless) their behavior distracts you or others in the class.
• Remind yourself: "If teaching were easy, everyone would be doing it." Teaching in front of a classroom full of children can be challenging, but on the other hand, very rewarding!
• Use classroom management techniques before you become irritated, impatient or upset. We are much more powerful when we are centered, when we like our children, and when we view our children with fondness rather than impatience.
• When you notice unproductive behavior, nip it in the bud. Otherwise, you send a clear message to the children that it's OK for them to talk while you are talking, etc.

Jake arrived at school after the school year was already underway. It should have come as no real surprise that he showed up at our door, since he has been enrolled in several schools -- including ours once before -- in the past two years. The word was out that, while enrolled in his last school, Jake had accumulated an impressive record of poor academics and behavior. In one incident, he threw a chair at his teacher.

Soon after arriving at our school, Jake was assessed by the school support team and introduced to our class. He entered our classroom with his low-slung pants, exaggerated "gangsta" walk and mannerisms, a lousy attitude, and an enormous chip on his shoulder.

Six weeks later, he announced to our class, "At first Miss S was my worst enemy; today she is my best friend."

REACHING OUT TO JAKE’S MOTHER—

Miss Stevens used a variety of strategies to reach out to Jake and bring about the transformation described. Her first purposeful move was to reach out to Jake’s mother and make her an ally.

Jake’s mother, for a variety of reasons, had a lot of antagonism toward schools in general and toward our school in particular. For that reason, Miss Stevens had to focus on separating herself from the problems Jake’s mother perceived. It was important for Jake’s mother to know that Jake was his teacher’s primary concern, not previous issues with other teachers, children, or the school.

Miss Stevens’ years of teaching experience had taught her that no youngster is “all bad,” and that all parents need and deserve to hear positive things about the kids they love. She provided Jake’s mother with a regular flow of information. Whenever possible, that information celebrated news of good behavior and positive effort.

It wasn’t long before Jake’s mother began to respond to the conversations Miss Stevens initiated. Many people were surprised when Jake’s mother showed up at school for a scheduled conference -- after a string of no-shows for previous conferences. Miss Stevens’ effort to keep Jake’s mother informed -- always done with respect and courtesy -- had paid off, it seemed. She showed up at the conference because she felt “safe,” confident that she would not be attacked or blamed or put on the spot.

FROM CLASS TROUBLEMAKER TO TEACHER’S ASSISTANT!

With help from the school’s support staff, Jake soon had a chart on which his behavior was recorded at regular intervals during the day. Like all the other children in Miss Stevens’ class, Jake also had a "goal card;" punches on his goal card provided quick reinforcement of good decisions and behaviors throughout the day. Special attention was paid to Jake’s behavior during recess, lunch, and such special classes as art, music, and PE; historically, those less structured parts of the day had been problem times for Jake.

In Miss Stevens’ classroom, a completed goal card carries a reward. Jake usually chooses one particular reward -- the one that allows him to be Miss Stevens’ “teacher’s assistant” (TA) for a day. All the children understand the importance of that job. They know how Miss Stevens relies on her TAs. TAs wear special nametags and sit in a place of importance by her desk. They perform important tasks, including some simple discipline tasks such as rewarding "reading pillows" to those who are on task during literacy time.

When Jake chooses to be a TA, he takes pride in handling the job seriously. Most importantly, he seems to identify with the teacher’s role in helping children learn and behave responsibly. As a TA, Jake has come to understand that he and his peers bring problems on themselves when they make poor choices.

HEART-TO-HEART TALKS—

Miss Stevens uses another intervention with children that I call "heart-to-heart talks.” During her heart-to-hearts with Jake, she always makes certain he understands that she likes him very much -- even though she might not always like his behavior. She lets him know that her responses to his behavior are part of her job. It is her responsibility to make him a better student and help him learn. He might be angry about what she has to do, and he might even be angry at her for doing it, but she always takes time to remind him that she is not angry at him and that she cares about him. She tells him this even when he seems to be tuned out or is having a bad day.

From time to time, Stevens announces to Jake, “I'm so glad you're in my class.” And she means it! Now I'm willing to bet that's something he's never heard before!

This is not to say that Jake doesn't still test Miss Stevens by acting out occasionally, but he is learning that she does not give up on him. She holds high expectations for him, and she lets him know that she thinks he is capable of living up to those expectations.

Miss Stevens works on the premise that all kids need and deserve physical affection too. She makes sure Jake receives his share of shoulder-to-shoulder hugs, back and shoulder pats, and plenty of high-fives and smiles. In the beginning, Jake seemed a bit uncomfortable with that kind of attention and would stiffen his body. Miss Stevens didn’t react to that rejection, however. She knew his reaction might be caused by pent-up anger. Perhaps he reacted that way because accepting such attention was counter to the “tough guy” image he attempted to put up. Or maybe he just didn’t know how to respond. But it wasn’t long before Jake relaxed. Maybe other students’ responses to Miss Stevens’ physical attention modeled the appropriate behavior for Jake. In any case, now Jake even initiates high-fives!

AN ATMOSPHERE OF UNDERSTANDING—

In the classroom, Miss Stevens teaches all children to understand the behavior of their peers, especially those who might regularly exhibit poor behavior. She even enlists students’ help in applauding one another’s successes and mentoring each other to make the best choices.

Recently, during reading time, Jake and a group of his peers were discussing a passage about learning from mistakes. In the group, Jake volunteered that he has had to learn things "the hard way." Miss Stevens didn’t just let that revelation pass. She picked up on Jake’s comment. She was frank with the class about how difficult his student record had been and how hard he was working to improve it. The children picked up on the pride in her voice, and they echoed it to him. In addition, Miss Stevens regularly has Jake stand on his chair to receive special recognition from the class for a job well done.

Jake still makes mistakes. He still makes bad choices sometimes. But he is shedding his "bad boy" label as Miss Stevens continues to search for and refine ways to reach him and other troublesome children in her class.

Students who exhibit violent behavior present the most difficult challenge to educators and moms and dads. Such students may be defiant, sta...

Welcome to DifficultStudents.com

We have joined with Online Parent Support to create a single resource for parents, teachers, and mental health professionals who deal with the challenges of "difficult" children and teens.

This web site provides articles, educational resources, links to local, national and international support groups, sources of professional help, lists of camps and schools, conference information, recommended reading, and moderated support message boards.

We strongly believe that all children and teens faced with behavioral challenges have the right to – and deserve – appropriate education, inclusion, support, and understanding so they and their families may enjoy the highest possible quality of life.